OBJECTIVES: International Reference Pricing (IRP) is a powerful tool introduced to maximize treatment benefits, where payers are key customers. IRP system aims to reduce cost and make pharmaceuticals accessible to a larger number of patients. This policy leads to interdependency of prices affecting markets differentially. The objective of this study was to understand the changing landscape of IRP and its impact on the key stakeholders (payers, manufacturers and patients).

METHODS: A goal-oriented research was conducted using EMA, OECD and various pricing bodies in order to assess the pricing policies and launching sequence. Real world evidence was gathered using latest reports and published news as a part of grey literature.

RESULTS: Recently, some European countries like Greece, Croatia, Lithuania and Moldova have updated their IRP rules and even US is planning to implement IRP following footsteps of European market. In US IRP model would save $17 billion for Medicare in 5 years, which reflects huge cost saving for payers. Similarly, in European markets, healthcare system benefits from differential IRP policies. IRP is assumed to decrease medicine prices by about 15% after 10 years. High cost savings are associated with generics as the reference price is set at 69% of the price of the originator medicine in Belgium. For patients, IRP leads to monetary benefit by limiting co-payment with decreasing medicine prices. However, it has negative affects too, by limiting access to medicine in certain national markets. In case of manufacturers, evidence from CEE countries demonstrate that IRP leads to delayed or even no launch of medicinal products by manufacturers to avoid lowering prices, which ultimately affects the sales volume thus blocking the R&D for new molecules.

CONCLUSIONS: Based on the evidence presented, healthcare payers are mostly benefitted from the IRP policies whereas similar impact was not observed on patients and manufacturers.